Director, Care Management & Social Work - UH, UMMC, NWCH, CSHC in ROCHESTER, New York at Rochester Regional Health
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Job Description
DescriptionDirector, Care Management & Social WorkUnity Hospital, United Memorial Medical Center, Newark Wayne Community Hospital and Clifton Springs Hospital and Clinic
SUMMARY:
The Director is primarily responsible for managing utilization review and discharge planning activities, as well as addressing psychosocial needs to appropriately transition patients through the continuum of care. Working collaboratively with the MD Advisor for Care Management, the Director also is responsible for building coalitions with all members of the care team as well as hospital and health system leadership to implement changes to improve patient flow, the patient experience, and staff and physician satisfaction, as well as increase reimbursement and reduce denials.
RESPONSIBILITIES:
Lead the development, implementation, and evaluation of strategic department plans to optimize length of stay, discharge planning, patient flow, and resource utilization across the hospital.
Oversee utilization and denial management programs, ensuring appropriate levels of care, strong payer relationships, adherence to regulations, and proactive strategies to reduce denials and prevent readmissions.
Build and maintain effective internal and external partnerships to drive process improvement, monitor performance metrics, and support optimal clinical, operational, financial, and patient satisfaction outcomes.
Manage departmental operations including staffing, budgeting, role development, performance evaluations, regulatory compliance, and quality review processes.
Serve as a consultant and liaison for long-term care facilities and state agencies, ensuring regulatory alignment, supporting complex psychosocial needs, and guiding policy, risk management, and patient experience initiatives.
Perform other related duties as assigned.
REQUIRED QUALIFICATIONS:
BSN or Master's Degree in Social Work
RN or LMSW license
Minimum of five years in Health Care setting, three years in supervisory capacity
PREFERRED QUALIFICATIONS:
Case management/utilization review/discharge planning experience
EDUCATION:
- BS: Nursing (Required)
PHYSICAL REQUIREMENTS: S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
LICENSES/CERTIFICATIONS:
- RN - Registered Nurse - New York State Education Department (NYSED)
- BLS - Basic Life Support - American Heart Association (AHA)
PAY RANGE: $85,000.00 - $135,000.00
The listed base pay range is a good faith representation of current potential base pay for successful applicants. It may be modified in the future. Pay is determined by factors including experience, clinical licensure date, relevant qualifications, specialty, internal equity, location, and contracts.